Insurance AR/Eligibility Specialist

Responsibilities include, but are not limited to:

• Interview patients/family members (in-person/phone) to determine eligibility based on client guidelines and HIPAA regulations.
• Assist with applications for state, county, or government programs, ensuring all necessary documentation is collected.
• Submit completed applications for approval and follow up as needed.
• Ensure compliance with hospital, company, and departmental policies and procedures.
• Maintain daily contact with hospital departments and external entities regarding self-pay referrals.
• Maintain accurate financial records, including statistical data.
• Create detailed notes in the hospital or host system reflecting account actions.
• Initiate Presumptive Eligibility (PE) for Medicaid eligibility.
• Complete tasks within established timeframes and attend departmental meetings/training.

Additional Duties:

• Proficient in EMR and charge posting; submit clean claims electronically and maintain clearinghouse reports.
• Verify patient eligibility, resolve insurance denials, and submit secondary claims/appeals as needed.
• Address deductible, co-insurance, and co-pay questions and recommend coding changes.
• Perform soft collections and scrub Aged Trial Balance Reports for insurance discrepancies.
• Train team members and assist with internal audits.
• Review Denial Reports, update accounts, and generate bad debt and Medicaid eligible reports.
• Other duties as assigned.

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Paid time off
• Paid training
• Tuition reimbursement
• Vision insurance

• High school diploma or GED, minimum requirement
• Strong communication, including writing, speaking and active listening
• Great customer service skills, including interpersonal conversation, patience and empathy
• Good problem-solving and critical thinking skills
• Ability to multi-task and work in a hospital environment
• Organization, time management and prioritization abilities
• Understanding of industry-specific policies, such as HIPAA regulations for health care is helpful
• Attention to detail and excellent quality
• Proficient computer skills, Microsoft Office; working knowledge of billing software, electronic medical records (EMR) or hospital software systems is a plus

Physical Requirements:

• Team members are required to sit for an extended period, occasionally lift supplies/equipment, and move up to 25 pounds.
• Must travel for onsite work, training and attend client meetings as needed.